Sometimes I think that for psychiatry and psychiatrists, all behaviour is abnormal. Of course there is a vested financial interest for the discipline – which is a long way from being a science – to include as many behavioural conditions as possible within the definition of what is an ailment. In many countries it becomes of great benefit for the “patient” to be formally acknowledged to be suffering from an “ailment”. It can trigger insurance payments and be the qualification for financial and clinical support. The Diagnostic and Statistical Manual (DSM) of Mental Disorders produced by the American Psychiatric Association is the most influential standard for diagnosis in the US and is extensively used world-wide. Currently the 4th edition is in use (DSM IV) and the 5th edition, DSM V, is scheduled for release in May 2013. The debates and arguments about what is to be included or removed from DSM V is reminiscent of political lobbying!
I have the perception that far more behavioural conditions are included as “ailments” than should be. In that sense psychiatry causes more illness than it cures! The APA invites ridicule when it indulges in (Slate),
… rather inexpertly—debating whether avid shopping should be considered a sign of mental illness.
The APA isn’t just deciding the fate of shopaholics; it’s also debating whether overuse of the Internet, “excessive” sexual activity, apathy, and even prolonged bitterness should be viewed, quite seriously, as brain “disorders.” If you spend hours online, have sex more frequently than aging psychiatrists, and moan incessantly that the federal government can’t account for all its TARP funds, take heed: You may soon be classed among the 48 million Americans the APA already considers mentally ill.
Even the diagnosis of Attention Deficit-Hyperactivity Disorder (ADHD) has its share of controversy. Some sociologists consider ADHD to be a “classic example of the medicalization of deviant behavior, defining a previously nonmedical problem as a medical one”.
The production of DSM V is far from transparent and there have been many criticisms of the ties to industry interests
In a recent Point/Counterpoint article, Lisa Cosgrove, PhD and Harold J. Bursztajn, MD noted that “the fact that 70% of the task force members have reported direct industry ties—an increase of almost 14% over the percentage of DSM-IV task force members who had industry ties—shows that disclosure policies alone, especially those that rely on an honor system, are not enough and that more specific safeguards are needed.”
And now it seems that Asperger’s syndrome will no longer be considered a mental ailment. While the shortening of the list of ailments is welcome that will be no comfort for those who have already been diagnosed as suffering from the syndrome. In fact a UK hacker recently succeeded in avoiding deportation to the US on the grounds that he had Aspergers. It is the seemingly arbitrary nature of what goes into DSM V and what does not that is offensive:
Asperger’s syndrome is to be dropped from the psychiatrists’ Diagnostic and Statistical Manual (DSM) of Mental Disorders, the American publication that is one of the most influential references for the profession around the world.
The term “Asperger’s disorder” will not appear in the DSM-5, the latest revision of the manual, and instead its symptoms will come under the newly added “autism spectrum disorder”, which is already used widely. That umbrella diagnosis will include children with severe autism, who often do not talk or interact, as well as those with milder forms.
… Full details of all the revisions will come in May 2013 when the American Psychiatric Association’s new diagnostic manual is published. The changes will affect the diagnosis and treatment of millions of children and adults worldwide, as well as medical insurance and special education services.
Tags: American Psychiatric Association, APA, Asperger, Asperger syndrome, DSM, DSM-5, Mental disorder
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